Gennheimer Valérie, Akhoundova Dilara, Hoffmann Michèle, Jeker Barbara, Banz Yara, Bacher Ulrike, Pabst Thomas
Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Institute of Pathology, University of Bern, 3010 Bern, Switzerland.
Cancers (Basel). 2025 Apr 11;17(8):1297. doi: 10.3390/cancers17081297.
Patient management following a multidisciplinary tumor board (MTB) recommendation has become standard of care in oncology and aims to ensure optimization and personalization of patient care. To assess the impact of MTB recommendations in clinical practice, adherence to the recommended procedures needs to be evaluated. Within this retrospective case series, we examined adherence rates to recommendations formulated at multidisciplinary myeloma tumor boards (MMTB) held at our institution. Specifically, we analyzed how often recommendations involving diagnostic procedures, therapies, and enrollment into clinical trials recommended by the MMTB were implemented. In addition, factors leading to non-adherence were evaluated.
We reviewed all consecutive patient cases discussed at MMTBs held at the University Hospital of Bern, Switzerland, between 1 January and 31 December 2023. Adherence was assessed by systematically comparing all available clinical records with the recommendations formulated at the MMTBs.
In total, 218 patients were included in the study. Of all MMTB recommendations, 86% (n = 251) of all MMTB recommendations were followed. Of these, 84% (n = 244) were followed with complete adherence and 2% (n = 7) incompletely. All cases of non-implementation of MMTB recommendations concerning diagnostics or therapy were clinically justified. The main reason for non-adherence was patient decision. Other reasons included lack of cost coverage and relevant changes in the clinical scenario, including patient's death. In total, 36% (n = 104) of MMTB recommendations included clinical trial enrollment. However, study enrollment occurred only in 32% (n = 33) of the 104 cases. In 41% (n = 29) of the cases, justification for non-enrollment was documented in the clinical records. The most frequent reasons were patient decision, unmet inclusion criteria, delays in recruitment, lack of reimbursement, and changes in the clinical scenario.
Our study showed an overall high level of adherence to MMTB recommendations for diagnostic procedures and therapy. However, only one third of recommendations for clinical trial enrollment were implemented, frequently due to patient decisions. Our results highlight the relevance of regular assessments of adherence rates to MTB recommendations and suggest that considering patient preferences in MTB discussions might minimize deviations.
遵循多学科肿瘤委员会（MTB）的建议进行患者管理已成为肿瘤学的护理标准，旨在确保患者护理的优化和个性化。为了评估MTB建议在临床实践中的影响，需要评估对推荐程序的依从性。在这个回顾性病例系列中，我们检查了在我们机构举行的多学科骨髓瘤肿瘤委员会（MMTB）制定的建议的依从率。具体而言，我们分析了MMTB推荐的涉及诊断程序、治疗以及参加临床试验的建议的实施频率。此外，还评估了导致不依从的因素。
我们回顾了2023年1月1日至12月31日期间在瑞士伯尔尼大学医院举行的MMTB讨论的所有连续患者病例。通过系统地将所有可用临床记录与MMTB制定的建议进行比较来评估依从性。
该研究共纳入218例患者。在所有MMTB建议中，86%（n = 251）得到了遵循。其中，84%（n = 244）被完全遵循，2%（n = 7）未完全遵循。所有未实施MMTB关于诊断或治疗建议的病例在临床上都有合理理由。不依从的主要原因是患者的决定。其他原因包括缺乏费用覆盖以及临床情况的相关变化，包括患者死亡。总共有36%（n = 104）的MMTB建议包括临床试验入组。然而，在这104例中只有32%（n = 33）进行了研究入组。在4（n = 29）的病例中，临床记录中记录了不入组的理由。最常见的原因是患者的决定、未满足纳入标准、招募延迟、缺乏报销以及临床情况的变化。
我们的研究表明，对于诊断程序和治疗，对MMTB建议的总体依从性较高。然而，只有三分之一的临床试验入组建议得到实施，这通常是由于患者的决定。我们的结果强调了定期评估对MTB建议依从率的相关性，并表明在MTB讨论中考虑患者偏好可能会减少偏差。
